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General NPI Number Information
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NPI Number | 1487743985
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY DENTISTRY INC PS
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20101 44TH AVE WEST SUITE G
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City | LYNNWOOD
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State | WA
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Zip | 98036-6745
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Country | US
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Telephone | 425-640-0207
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Fax | 425-640-0571
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Provider Business Mailing Address
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Address Line | 20101 44TH AVE WEST SUITE G
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City | LYNNWOOD
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State | WA
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Zip | 98036-6745
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Country | US
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Telephone | 425-640-0207
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Fax | 425-640-0571
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROMANINE LOCH
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Credential | DMD
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Telephone | 425-640-0207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE8560
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License Number State | WA
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